Quarter 3 Performance Report 2018/19 Health O&S Sub-Committee 19 February 2019
About the Health O&S Committee Performance Report • Overview of the Council’s performance against the indicators selected by the Health Overview and Scrutiny Sub-Committee • The report identifies where the Council is performing well ( Green ), within target tolerance ( Amber ) and not so well ( Red ). • Where the rating is ‘ Red ’, ‘ Corrective Action ’ is included. This highlights what action the Council will take to address poor performance.
OVERVIEW OF HEALTH INDICATORS • 3 Performance Indicators are reported to the Health Overview & Scrutiny Sub- Committee. • Performance ratings are available for all 3 indicators. Q3 indicators summary Amber Red Of the 3 indicators: 2 (67%) have a status of Amber (within tolerance) 1 (33%) has a status of Red (off target)
Quarter 3 Performance 2018/19 2018/19 Q3 2018/19 Q3 Short Term DOT against Long Term DOT against Indicator and Description Value Tolerance Service Annual Target Target Performance Q1 2018/19 Q3 2017/18 10.9% (2016/17) Obese Children (4-5 years) Smaller is Similar to Better than Better than 10.8% Public RED - N/A (Annual) better England England (9%) England (9%) (2015/16) Health Worse than England Percentage of patients whose 64% overall experience of out-of - Better than Better than (2018) Bigger is Similar to 67% Havering hours services was good England England AMBER - N/A better England (July 2017) CCG (Partnership PI) (69%) (69%) Similar to (Annual) England The number of instances where an adult patient is ready to leave hospital for home or move to a less acute stage of Smaller is Adult Social ±10% 7 7 7.4 7.8 5.1 care but is prevented from better Care doing so, per 100,000 population (delayed transfers of care)
About Childhood Obesity • Prevalence of obesity amongst 4-5 year olds in Havering has seen no significant change over the past 9 years. In 2016/17 Havering’s performance remained significantly worse than England but similar to London . Percentage of Obese Children, Havering, London & England, 2007/08 – 2016/17 14 12 10 Percentage (%) 8 Havering London 6 England 4 2 0 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 Year Source: Public Health England
Improvements Required: Childhood Obesity • Directed by Havering’s ‘Prevention of Obesity Strategy 2016 - 19’, our borough working group continues to progress actions that are within the gift of the local authority and partners, and within available budgets. • Progress on actions since the last update are as follows: A bid was submitted to the Childhood Obesity Trailblazer Programme fund that, if successful, in the initial phase will focus on engaging communities in Harold Hill and Rainham to develop their own solutions to tackling obesity. A bid has also been submitted for funding of five public water fountains across the borough to encourage people to drink water instead of sugary drinks and reduce their plastic waste by refilling water bottles. Obesity has been incorporated into the Council’s Local Implementation Plan as part of the Healthy Streets Approach. A further six Early Years settings in Havering have registered with the Healthy Early Years programme taking the total to 38. Sixteen have completed First Steps, four achieved the Bronze award and two the silver award. Everyone Active is piloting a 12-week adult weight management programme at Hornchurch Leisure Centre combining nutrition advice and physical activity for individuals with a BMI of over 25. HES Catering has promoted a SugarSmart campaign in secondary schools and will be introducing a traffic light system for menu items. A weekly lunchtime walk has been introduced for LBH staff and changes have also been made in the Pantry, reducing sugar, introducing wholemeal pasta, reducing the price of water and adding more beans and pulses to the salad bar. • Obesity is a complex issue and many of the opportunities to tackle it fall outside of the local authority’s influence. As such, work continues at national level, guided by the national ‘Childhood Obesity: A Plan for Action’ and we continue to link with national campaigns and programmes where appropriate.
About Patient Experience of GP Out-of-hours Services • The latest available data (2018) for patient experience of GP out-of-hours services shows no significant difference between the percentage of patients who are satisfied with the service in Havering (64%, 95%CI: 59%-68%) and the England average (69%, 95%CI: 68%-69%). This follows an overall improvement in the England average performance as compared to the previous year (2017 – 66%) whereas Havering’s performance has not significantly changed. Use of out-of-hours services includes contacting an NHS service by phone (e.g. 111) and going to A&E - which a vast proportion (54% and 31% respectively) of the 882 Havering respondents who answered this question say they did. The percentage of patients who are satisfied with the GP out of hours services, Havering & England 2012 - 2018 80 70 Percentage (%) 60 50 40 Havering 30 England 20 10 0 2012 2013 2014 2015 2016 2017 2018 Year Source: NHS Digital & GP Patient Survey Database
Considerations for: Patient feedback on Out of Hours Services • When practices are closed (outside of 8 am – 6.30 pm) they can provide their own Out of Hours (OOHs cover) or ‘opt - out’. If a practice ‘opts out’ the commissioner is responsible for ensuring appropriate OOHs cover is in place. • In Havering, all practices have opted out of OOHs, therefore the CCG commissions PELC to provide OOHs cover in which the clinical responsibility for patients is transferred to the OOHs provider. PELC provide services out of hours on the Queens and King George hospital sites and at Grays Court in Dagenham. • London Ambulance Service took over 111 services from 1 st August – they were previously provided by PELC. 111 are able to book patients into the GP OOH and the GP access hub services. There are seven GP hubs providing an out of hours service across BHR, two of which are in Havering, at Rosewood Medical Centre and North Street Medical Centre. • A number of factors affecting use of OOHs have changed as part of the NHSE London Access strategy reflecting the ambition of the General Practice Forward View (GPFV). This includes increasing the number of slots offered by the GP access hub. • The survey results are now collected only once per annum rather than every six months and are therefore slower to reflect changes. Trends will therefore only be discernible from the July 2017 data collection point onwards.
About Delayed Transfer of Care • In the first eight months of 2018/19, there has been an average of 14.75 delayed discharges per month (7.4 days per 100,000) whereas at the same stage last year there had been an average of approximately 10. • The vast majority of delays are in the acute sector and are the responsibility of Health. • There was an increase in delays attributable to Social Care during the second quarter of the year, which continues to affect cumulative performance but the direction of travel over the past three months has been positive. There were a small number of lengthy delays in the summer due to the sourcing of specialist support. Some out of borough hospitals also reported delays against Havering which are being followed up. • Actions being put in place to reduce delayed discharges include: - Care Homes in Havering being supported to create a 'Trusted Assessor' role, based primarily in BHRUT; - Establishment of a pilot bringing together therapy resources in BHRUT and NELFT to manage the hospital / community interface differently; - Simplification of discharge processes, including a revised screening and referral process for NELFT inpatient rehab beds.
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